MEDICAL PROFESSIONALS

Therapy Options

The evolution of catheter ablation

Initial attempts at catheter ablation almost 20 years ago mimicked the Maze procedure with a series of linear lesions created by a radiofrequency catheter. While these first efforts had limited success rates, catheter ablation has undergone significant evolution following the pivotal discovery by Haïssaguerre and colleagues that the pulmonary veins are an important source of ectopic triggers (ref. 16). In fact, the pulmonary veins can be very effectively disconnected by radiofrequency catheter ablation.

Subsequently two major techniques arose, namely ostial segmental disconnection and circumferential pulmonary vein ablation, while today the methodology somewhat converged to disconnect the pulmonary veins and ablate nearly all aberrant electrical triggers. Lesions on the inside of the ostia are made towards the atrium in order to reduce the risk of stenosis; generally areas of the left atrium are included that are potentially arrhythmogenic due to the presence of peri-ostial foci, rotors, and parasympathetic ganglia (ref. 17).

Figure: Image of ablation lines - indicating PV isolation, linear lesions